车前地黄汤联合西药治疗慢性痛风性关节炎的临床观察

Clinical observation on Cheqian Dihuang Decoction combined with western medicine in the treatment of chronic gouty arthritis

目的:评价车前地黄汤联合西药治疗痰瘀互结型慢性痛风性关节炎的临床疗效。方法:纳入84例痰瘀互结型慢性痛风性关节炎患者,随机分为治疗组和对照组,每组各42例。治疗组患者给予车前地黄汤联合非布司他片口服治疗,对照组患者给予非布司他片口服治疗,治疗周期均为120 d。分别于治疗120 d后及停药60 d后,评价两组患者的临床疗效;分别于治疗前、治疗120 d后及停药60 d后,检测并比较两组患者的血尿酸(UA)、C反应蛋白(CRP)、血沉(ESR)水平,评价两组患者的中医证候评分。结果:①治疗120 d后,治疗组的临床总有效率为95.0%,对照组为87.2%,两组间疗效比较,差异有统计学意义(P<0.05),治疗组的疗效优于对照组;停药60 d后,治疗组的临床总有效率为92.5%,对照组为79.5%,两组间疗效比较,差异亦有统计学意义(P<0.05),治疗组的疗效优于对照组。②治疗120 d后及停药60 d后,两组患者的中医证候评分较治疗前均明显降低(P<0.01),且治疗组患者的评分低于对照组(P<0.01)。③治疗120 d后及停药60 d后,两组患者的血UA水平较治疗前均显著降低(P<0.01);停药60 d后,治疗组患者的血UA水平较治疗120 d后亦显著降低(P<0.01),且治疗组患者的血UA水平低于对照组(P<0.05)。治疗120 d后,两组患者的血UA达标情况比较,差异无统计学意义(P>0.05);停药60 d后,治疗组患者的血UA达标情况较治疗120 d后明显改善(P<0.05),且治疗组患者的血UA达标情况优于对照组(P<0.05)。④治疗120 d后及停药60 d后,两组患者的CRP、ESR水平较治疗前均显著降低(P<0.05,P<0.01),且治疗组患者的CRP、ESR水平均低于对照组(P<0.05,P<0.01);停药60 d后,治疗组患者的CRP、ESR水平较治疗120 d后亦显著降低(P<0.05,P<0.01)。结论:车前地黄汤联合西药治疗痰瘀互结型慢性痛风性关节炎具有较好的临床疗效,可有效降低患者的血UA水平,改善中医证候,抑制炎症反应。

Objective:To evaluate the clinical efficacy of Cheqian Dihuang Decoction combined with western medicine in treating patients of chronic gouty arthritis with syndrome of intermingled phlegm and blood stasis.Methods:Eighty-four patients of chronic gouty arthritis with syndrome of intermingled phlegm and blood stasis were included and randomly divided into the treatment group and control group,42 cases in each group.The patients in the treatment group were orally treated with Cheqian Dihuang Decoction combined with febuxostat tablets,and the patients in the control group were orally treated with febuxostat tablets,with a course of 120 days.One hundred and twenty days after treatment and 60 days after drug withdrawal,the clinical efficacy of the two groups was evaluated.Before treatment,120 days after treatment and 60 days after drug withdrawal,the levels of serum uric acid(UA),C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)were measured and compared,and the scores of Chinese medical syndrome in both groups were evaluated.Results:①One hundred and twenty days after treatment,the total effective rates were 95.0%in the treatment group and 87.2%in the control group,with statistically significant difference between the two groups(P<0.05),and the efficacy of the treatment group was better than that of the control group;60 days after drug withdrawal,the total effective rates were 92.5%in the treatment group and 79.5%in the control group,with statistically significant difference between the two groups(P<0.05),and the efficacy of the treatment group was better than that of the control group.②One hundred and twenty days after treatment and 60 days after drug withdrawal,the scores of Chinese medical syndrome were significantly decreased in both groups compared with before treatment(P<0.01),and the scores of the treatment group were lower than those of the control group(P<0.01).③One hundred and twenty days after treatment and 60 days after drug withdrawal,the serum levels of UA were significantly decreased in both groups compared with before treatment(P<0.01);60 days after drug withdrawal,the serum level of UA in the treatment group was decreased compared with 120 days after treatment(P<0.01),and the serum level of UA in the treatment group was lower than that in the control group(P<0.05).One hundred and twenty days after treatment,there was no statistically significant difference in the serum UA level up to standard between the two groups(P>0.05);60 days after drug withdrawal,the serum UA level up to standard in the treatment group was obviously improved compared with 120 days after treatment(P<0.05),and the serum UA level up to standard in the treatment group was superior to the control group(P<0.05).④One hundred and twenty days after treatment and 60 days after drug withdrawal,the levels of CRP and ESR were significantly decreased in both groups compared with before treatment(P<0.05,P<0.01),and the levels of CRP and ESR in the treatment group were lower than those in the control group(P<0.05,P<0.01);60 days after drug withdrawal,the levels of CRP and ESR in the treatment group were significantly decreased compared with 120 days after treatment(P<0.05,P<0.01).Conclusion:Cheqian Dihuang Decoction combined with western medicine shows good clinical efficacy in the treatment of chronic gouty arthritis with syndrome of intermingled phlegm and blood stasis,which can effectively reduce the serum level of UA,improve the Chinese medical syndrome and inhibit the inflammatory reactions.